Dehydroepiandrosterone (DHEA) has been promoted by some members of the alternative medicine community and health food industry as a sexual potency enhancer, energy stimulator, and all around "Fountain of Youth" agent. Recognized androgenic side effects are hirsutism in women and acne in both sexes. Previously unrecognized but a likely additional side effect is cardiac arrhythmia. We report a possible association between DHEA and arrhythmia.

A 55-year-old man bought a bottle of 25-mg DHEA tablets at a local retail outlet. He began taking two tablets a day in early June 1997 and noticed palpitations within 2 weeks. He came to an emergency department for evaluation on 15 June 1997, where benign premature atrial contractions and some premature ventricular contractions were recognized. He was discharged with a prescription for propranolol, 10 mg three times daily as needed. He had been receiving dexfenfluramine hydrochloride (Redux, Wyeth-Ayerst, Philadelphia, Pennsylvania) for the previous 12 months and had discontinued use 2 weeks before initiating DHEA use. Thyroid-stimulating hormone levels, cardiac echocardiogram, potassium levels, blood chemistry, and an exercise stress test result were unremarkable. Use of DHEA was continued until September 1997 and then stopped. As long as the ß-blocker was used, no further palpitations occurred. Increased libido with a recurrence of morning erections had been noticed while the patient received DHEA, but no changes in mood or energy were reported.

On 18 January 1998, use of DHEA, 50 mg, was once again started. Arrhythmias recurred within 36 hours and were documented as premature atrial and premature ventricular contractions on a Holter monitor. These arrhythmias were controlled by atenolol, 25 mg twice daily. Use of DHEA was discontinued again.

This report of arrhythmia seemingly associated with initial exposure to DHEA and with rechallenge suggests that this hormone in high dosages (25 to 50 mg/d) may be an etiologic factor in palpitations. Physicians should ask patients presenting with palpitations if they are taking DHEA.